Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis

BACKGROUND: Sports-related concussion (SRC) is an injury with important implications, especially in collision and contact sports, and has a high symptom burden. Student athletes face particular psychosocial challenges, especially female students with pre-existing anxiety/depression are at increased risk for SRC, and have a higher symptom burden before and after injury. OBJECTIVES: Describing female SRC presenting features at a collegiate campus-based sports medicine service; examining the association of prior concussion history (PCONC) and pre-existing anxiety/depression (PMHDx) with SRC. METHODS: A retrospective cohort and statistical analysis (including corrected effect sizes) of Sport Concussion Assessment Tool (versions 3/5) data (Step 1: PCONC and PMHDx history; Step 2: symptom evaluation) of collegiate female athletes with SRC between 2012 and 2018. RESULTS: Forty females with SRC were identified (age 23 ± 3). The five most frequent symptoms were headache (n = 34; 85%), feeling slowed down (n = 33; 83%), pressure in head (n = 33; 83%), don’t feel right (n = 32; 80%) and fatigue/low-energy (n = 32; 80%). These five symptoms also had the highest self-rated severity (median (IQR): headache (3 (2–4)), feeling slowed down (3 (1–4)), fatigue/low-energy (3 (1–5)), don’t feel right (3 (1–4)) and pressure in head (3 (2–4)). PMHDx (n = 8; 62.9 vs 38.6; p = 0.0192; Hedges’ g(s) = 0.95; large ES), and not PCONC (n = 13; 51.0 vs 39.8; p = 0.2183; Hedges’ g(s) = 0.48; small ES) was associated with increased mean total symptom severity. CONCLUSION: Headache, feeling slowed down, pressure in head, don’t feel right and fatigue/low-energy had the highest symptom burden. Total symptom severity was no different in those with and without PCONC, but significantly higher in those with PMHDx.